Healthcare Provider Details

I. General information

NPI: 1114228723
Provider Name (Legal Business Name): NWI PATIENT CARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 S LAKE ST
GARY IN
46403-2473
US

IV. Provider business mailing address

5925 E. MELTON RD.
GARY IN
46403-4020
US

V. Phone/Fax

Practice location:
  • Phone: 219-939-8745
  • Fax: 219-939-8748
Mailing address:
  • Phone: 219-939-8745
  • Fax: 219-939-8748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number01026604A
License Number StateIN

VIII. Authorized Official

Name: MRS. JENNIE S. TEAGUE
Title or Position: CFO-OWNER
Credential:
Phone: 219-939-8745